Whitehead's hemorrhoidectomy. A useful surgical procedure in selected cases

At the present time Milligan-Morgan's operation is the most diffusely employed and is widely considered to be the most effective of the various surgical techniques for the treatment of hemorrhoids. In this study we report our experience with Whitehead's radical hemorrhoidectomy. In a 5-year period, 1450 patients with hemorrhoids were treated at our Coloproctologic Unit. We routinely carry out the Milligan-Morgan operation. Nevertheless, in 26 patients the Milligan-Morgan operation was judged to be impossible to perform, in that the prolapsed hemorrhoids were completely irreducible and it was not possible to distinguish and separate the three piles. These patients thus underwent Whitehead's radical hemorroidectomy. All the patients who underwent Whitehead's operation were discharged within the fifth post-operative day. No episodes of incontinence were observed in any patient. The patients were followed for three years after the operation. In only one case did we verify an anal substenosis three months after the operation, which resolved after the use of anal dilators for one month. The stenosis did not recur in the course of follow-up. There were no cases of mucosal ectropion. In conclusion, the type of hemorrhoidectomy which a surgeon performs is primarily based on the surgeon's experience and training. Nevertheless, a competently performed Whitehead's hemorrhoidectomy can give satisfying results. These results are explained by improved knowledge of the anatomy of the anal region and a more accurate surgical technique. On the basis of our experience we believe that Whitehead's hemorrhoidectomy still has its place in selected cases with precise indications.